A variation on the same pathway, unappetizingly called the "fecal-oral route," is the main way people get infected with the bacteria and viruses that cause most cases of food poisoning and other intestinal maladies.
An infected person — perhaps a restaurant sous chef — uses the bathroom and fails to wash up. Or a harried dad changes his sick baby's diaper and doesn't scrub afterward. The chef passes the bug directly to customers who eat the salads she prepares. The dad may punch an elevator button with his dirty fingers, leaving bacteria lurking for the next passengers.
That's why good hand washing is doubly important after using the bathroom, Larson said. Not only are you exposed to the germs other people left on surfaces, like the stall door, but if you don't clean your hands, you can pass your germs on to others and even re-infect yourself.
Scoffers abound
Despite years of nagging from their mothers, many people still saunter out of the bathroom with hands that would set off a germ alarm.
When researchers for the American Society of Microbiology quizzed people in a phone survey in August, 95 percent swore they washed their hands every time they used the restroom. But when the researchers loitered in airport restrooms, they found a different story. On average, 22 percent of people sidestepped sinks as if they were allergic to soap and water, says a report issued last month.
That's an improvement over surveys last year and in 1996, when the unwashed accounted for a full third of travelers.
The best performance was in Toronto, the site of a frightening outbreak of SARS this spring. Health officials issued daily reminders about the importance of clean hands — and people apparently paid attention. About 95 percent of travelers washed their hands before heading back to the concourse.
Even in hospitals, where workers are constantly reminded of the importance of clean hands, hand-washing habits are not exemplary. More than 2 million patients contract infections in hospitals and nursing homes each year and an estimated 90,000 die as a result. And surveys still show many doctors and nurses don't wash before every procedure or patient exam.
Many people pooh-pooh the need for hand washing in a modern society, said Will Shelton, infection-control manager for Swedish Medical Center in Seattle.
"We certainly have the perception that if you get sick you just take a pill," he said. "But our complacency is false and misplaced."
Proof of the power
Austrian physician Ignaz Semmelweis was the first to realize the importance of clean hands in medicine. He noticed high rates of infection and death among new mothers at his Vienna hospital in 1847, where student doctors delivered babies after working on cadavers in anatomy class. Better hand washing and chlorine rinses eliminated the problem.
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How to wash your hands
• Wet your hands with warm water and apply liquid or bar soap.
• Rub your hands vigorously together, paying close attention to areas in and around the nails and between the fingers.
• Wash for 15-20 seconds, long enough to hum the "Happy Birthday" song twice.
• Rinse well.
• To avoid recontaminating your hands, use your elbow or a piece of paper towel to turn off the faucet.
• If you don't have access to a sink, use an alcohol gel.
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Contemporary research reaffirms the value of clean hands for everyone.
Detroit children who washed their hands four or more times a day missed 50 percent fewer school days from stomach ailments and 25 percent fewer days from colds than kids who didn't wash as religiously. A study of 23 Australian day-care centers found similar results.
Hepatitis A infections and bacterial food poisoning plummeted in Pierce County after the local health department launched the state's most extensive hand-washing education campaign in 1996.
"We can't really prove that's due to the hand-washing program," said coordinator Diane Westbrook, " but we think it played a role."
When a Pierce County school was struck recently by an outbreak of viral stomach flu similar to the intestinal bug responsible for ruining many cruise-ship vacations, health workers conducted a crash course in hand washing for students and teachers. Within a day, the number of new infections dwindled nearly to zero.
Once a lackluster washer, Westbrook has become a disciple.
"I used to get a lot of colds, and I don't anymore," she said. "I attribute that to washing my hands several times a day, especially when I've been out and about, touching things."
What to use?
Ordinary soap and warm water are all you need for effective hand washing.
Germicidal and antibacterial soaps don't provide any additional protection, Larson found in a yearlong study. She divided nearly 250 households into two groups. One used regular soap while the other used antibacterial products.
"There was absolutely no difference whatsoever in the bacterial counts on the hands of either group," she said.
Health officials recommended against antibacterial products out of concern they may spawn resistant strains of bacteria.
But health experts are excited about the newest hand-washing sensation: alcohol gels. Available in squirt and pump bottles, these "hand sanitizers" can be rubbed on anywhere and evaporate quickly.
They're also more effective than plain soap at removing germs, Larson said.
The CDC recently recommended them for use in hospitals.
"You can use them anywhere," Larson said. "You don't need a sink. You don't need a towel."
But experts caution against turning concern about clean hands into obsession.
The world is brimming with bacteria and viruses, most of which are innocuous. Some are even important to help charge up your immune system and keep more dangerous germs at bay.
"You're not trying to sterilize your hands," said Dr. Jeff Duchin, infectious disease chief for Public Health-Seattle & King County. "You're just trying to reduce the number of pathogenic bugs that were just dripped out of someone's nose." |
